1
|
Kuczynski AM, Piccirillo ML, Dora J, Kuehn KS, Halvorson MA, King KM, Kanter JW. Characterizing the momentary association between loneliness, depression, and social interactions: Insights from an ecological momentary assessment study. J Affect Disord 2024; 360:376-386. [PMID: 38823593 DOI: 10.1016/j.jad.2024.05.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and ∼2.5h and ∼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention.
Collapse
Affiliation(s)
- Adam M Kuczynski
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America.
| | | | - Jonas Dora
- Department of Psychology, University of Washington, United States of America
| | - Kevin S Kuehn
- Department of Medicine, University of California, San Diego, United States of America
| | - Max A Halvorson
- School of Social Work, University of Washington, United States of America
| | - Kevin M King
- Department of Psychology, University of Washington, United States of America
| | - Jonathan W Kanter
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| |
Collapse
|
2
|
Luoma I, Korhonen M, Salmelin RK, Siirtola A, Mäntymaa M, Valkonen-Korhonen M, Puura K. Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood. J Affect Disord 2024; 361:299-309. [PMID: 38876318 DOI: 10.1016/j.jad.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS Maternal and child measures were based on maternal reports only. CONCLUSIONS The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.
Collapse
Affiliation(s)
- Ilona Luoma
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Child Psychiatry, Kuopio, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Marie Korhonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Helsinki University Hospital, Department of Child Psychiatry, Helsinki, Finland
| | - Raili K Salmelin
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Arja Siirtola
- Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Mirjami Mäntymaa
- University of Oulu, Faculty of Medicine, Oulu, Finland; Oulu University Hospital, Department of Child Psychiatry, Oulu, Finland
| | - Minna Valkonen-Korhonen
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Psychiatry, Kuopio, Finland
| | - Kaija Puura
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| |
Collapse
|
3
|
Falck FAOK, Dhejne CMU, Frisén LMM, Armuand GM. Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1981-2002. [PMID: 38228983 PMCID: PMC11106200 DOI: 10.1007/s10508-023-02787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.
Collapse
Affiliation(s)
- Felicitas A O K Falck
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Psychiatry Southwest, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
| | - Cecilia M U Dhejne
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Louise M M Frisén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gabriela M Armuand
- School of Health and Welfare, Faculty of Health Sciences 1, Dalarna University, Falun, Sweden
| |
Collapse
|
4
|
Zhu Y, Li X, Chen J, Gong W. Perinatal depression trajectories and child development at one year: a study in China. BMC Pregnancy Childbirth 2024; 24:176. [PMID: 38448846 PMCID: PMC10918895 DOI: 10.1186/s12884-024-06330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The objective of the current study was to investigate the correlation between trajectories of maternal perinatal depression (PND) spanning from early pregnancy to one year postpartum and developmental delays observed in one-year-old children. METHODS The dataset under examination encompassed 880 women who took part in a mother-child birth study conducted in China. Latent class growth analysis (LCGA) was employed to identify patterns in Edinburgh Postnatal Depression Scale (EPDS) scores of women, spanning from early pregnancy to one year postpartum. To assess the neurodevelopment of one-year-old children, a Chinese version of the Bayley Scale of Infant Development (BSID-CR) was employed. Logistic regression was employed to explore the association between PND trajectories and developmental delays in children, with appropriate covariate adjustments. RESULTS The trajectories of maternal PND identified in this study included a minimal-stable symptom group (n = 155), low-stable symptom group (n = 411), mild-stable symptom group (n = 251), and moderate-stable symptom group (n = 63). Logistic regression analysis revealed that mothers falling into the moderate-stable symptom group exhibited a notably heightened risk of having a child with psychomotor developmental delays at the age of one year. CONCLUSIONS The findings drawn from a representative sample in China provide compelling empirical evidence that bolsters the association between maternal PND and the probability of psychomotor developmental delays in children. It is imperative to develop tailored intervention strategies and meticulously design mother-infant interactive intervention programs for women with PND.
Collapse
Affiliation(s)
- Yuan Zhu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiaoyu Li
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Hunan, China
| | - Junyu Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Hunan, China.
- Department of Psychiatry, University of Rochester, Rochester, New York, USA.
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Xiangya School of Public Health, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, 410006, Hunan, China.
| |
Collapse
|
5
|
Bladh M, Sydsjö G, Ekselius L, Vingård E, Agnafors S. Sense of coherence and health in women: a 25-year follow-up study. BMC Womens Health 2023; 23:670. [PMID: 38093276 PMCID: PMC10720174 DOI: 10.1186/s12905-023-02834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Health and Sense of Coherence (SOC) has been shown to be intertwined and argued to have a reciprocal relationship. The theory of SOC implies relatively stable scores during adulthood, however there are few longitudinal studies on the association between SOC and mental and somatic health. The main aim of the present study was to examine how SOC and self-rated health (SRH) are related during 25 years of follow-up. METHODS Using paper questionnaires distributed by postal services, 415 mothers were followed from childbirth and 25 years prospectively. SOC was measured at three, 12 and 25 years after inclusion. Self-reports on health status were obtained at the 25-year follow-up. The association between SOC and self-reported health as well as the effect of sociodemographic factors and experience of stressful life events was assessed through regression models. RESULTS SOC scores increased between three and 12 years after inclusion, and slightly decreased at the 25-year follow-up. Women of good health had a higher SOC-score at all three measurements compared to women of poor health. Multiple logistic regression showed that the likelihood of reporting good health increased with the number of times the women had reported SOC-scores above the 75th percentile. Moreover, women who had not been through a divorce were close to 60% more likely to report good health compared to women who had been through a divorce, whereas women not reporting stressful life events during the past two years were more than twice as likely to report good health. Symptoms below cut-off for postpartum depression and not having been through a divorce were associated with SOC scores above the 75th percentile. CONCLUSION This 25-year follow-up study of a cohort of women reports good stability of SOC assessments in the vast majority of women. There was a stronger and more stable SOC in women with better health. The findings are in line with other studies on the predictive value of SOC and self-perceived health.
Collapse
Affiliation(s)
- Marie Bladh
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden.
| | - Gunilla Sydsjö
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden
| | - Lisa Ekselius
- Women's Mental Health during the Reproductive Lifespan, Department of Women's and Children's Health, Uppsala University, Uppsala, SE-75185, Sweden
| | - Eva Vingård
- Department of Occupational and Environmental Medicine, Uppsala University, Uppsala, SE-75185, Sweden
| | - Sara Agnafors
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
| |
Collapse
|
6
|
Onishi R, Tone H, Kubota M, Chino N, Maruyama F. Associating Parental Efficacy with the Utility of Smart Devices: A Cross-Sectional Study of Their Role in Alleviating Maternal Parenting Concerns among Infants Aged 6-11 Months. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1437. [PMID: 37761398 PMCID: PMC10528665 DOI: 10.3390/children10091437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023]
Abstract
In digital societies, the use of smart devices to solve childcare problems has become commonplace. Mothers are influenced both positively and negatively by smart devices used to resolve childcare concerns. Focusing on parental self-efficacy, this study identified the factors associated with relief and anxiety caused by the use of smart devices to eliminate parenting concerns among mothers with infants. A random sampling cross-sectional survey was administered to 257 Japanese mothers with infants aged 6-11 months. Structural equation modeling was used to explain the relief and anxiety caused by their use of smart devices in terms of maternal demographics, parental self-efficacy, smart-device dependence, and confidence in their ability to discriminate information. Mothers with high parental self-efficacy experienced increased relief and reduced anxiety by using smart devices to address concerns about child-rearing practices. Mothers who were highly dependent on smart devices felt more secure with their use of smart devices. Homemakers and highly educated mothers who used smart devices because of concerns regarding child health and development experienced more anxiety. Parenting professionals need to recognize the effectiveness of smart devices as a tool to relieve anxiety in parenting and provide additional support for parents to improve their parenting self-efficacy.
Collapse
Affiliation(s)
- Ryuta Onishi
- Faculty of Nursing, Toyama Prefectural University, 2-2-78, Nishinagae, Toyama-shi 930-0975, Toyama-ken, Japan
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0812, Hokkaido, Japan
| | - Hanami Tone
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0812, Hokkaido, Japan
| | - Minori Kubota
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0812, Hokkaido, Japan
| | - Nana Chino
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0812, Hokkaido, Japan
| | - Funa Maruyama
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo-shi 060-0812, Hokkaido, Japan
| |
Collapse
|
7
|
Putnick DL, Bell EM, Ghassabian A, Mendola P, Sundaram R, Yeung EH. Maternal antenatal depression's effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators. J Affect Disord 2023; 324:424-432. [PMID: 36565964 PMCID: PMC9885303 DOI: 10.1016/j.jad.2022.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2-3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices. METHODS Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months. RESULTS In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates. LIMITATIONS Main limitations were the relatively advantaged sample and reliance on maternal report. CONCLUSIONS Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention.
Collapse
Affiliation(s)
- Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA.
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, USA
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, USA
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| |
Collapse
|
8
|
Johann A, Dukic J, Rothacher Y, Ehlert U. Trajectories of reproductive transition phase mood disorder from pregnancy to postpartum: A Swiss longitudinal study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221147391. [PMID: 36748405 PMCID: PMC9909046 DOI: 10.1177/17455057221147391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depressive symptoms are common in the peripartum period and pose a great risk to the well-being of the mother, the infant, and the entire family. Evidence from longitudinal studies suggests that affected women do not constitute one homogeneous group in terms of severity, chronicity, and onset of symptoms. To account for individual differences regarding the longitudinal course of depressive symptoms from pregnancy to the postpartum period, growth mixture models have proven to be useful. METHODS We conducted a group-based trajectory modeling analysis to identify perinatal depressive symptom trajectories in a Swiss sample (n = 151). Depressive symptoms were assessed six times, covering nearly 6 months from the third trimester of pregnancy to 3 months postpartum. In addition to determining perinatal depressive symptom trajectories, we aimed to examine whether these trajectories are linked to psychopathological risk factors such as a history of premenstrual syndrome (PMS), anxiety, prenatal stress, and somatic symptoms after delivery that are associated with hormonal fluctuations. RESULTS The findings revealed three trajectories of perinatal depressive symptoms that were relatively stable over time and differed in symptom load (low, medium, high), as well as one trajectory of decreasing symptoms, with a significant symptom reduction after giving birth. Women with a higher depressive symptom load experienced a greater degree of prior premenstrual symptoms, prenatal anxiety, and birth anxiety, as well as somatic symptoms after delivery. CONCLUSION Further research is needed to account for the distinct trajectories of perinatal depressive symptoms in order to provide appropriate care for affected women. A focus on somatic symptoms after delivery and their association with depressive mood is essential to better understand the potential shared etiopathology of reproductive transition phase mood disorders.
Collapse
Affiliation(s)
- Alexandra Johann
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Jelena Dukic
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Yannick Rothacher
- Psychological Methods, Evaluation and Statistics, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland,Ulrike Ehlert, Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland.
| |
Collapse
|
9
|
Lin S, Wu Y, He L, Fang Y. Prediction of depressive symptoms onset and long-term trajectories in home-based older adults using machine learning techniques. Aging Ment Health 2023; 27:8-17. [PMID: 35118924 DOI: 10.1080/13607863.2022.2031868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Our aim was to explore the possibility of using machine learning (ML) in predicting the onset and trajectories of depressive symptom in home-based older adults over a 7-year period. METHODS Depressive symptom data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2650) recruited in the China Health and Retirement Longitudinal Study (CHARLS) were included in the current analysis. The latent class growth modeling (LCGM) and growth mixture modeling (GMM) were used to classify different trajectory classes. Based on the identified trajectory patterns, three ML classification algorithms (i.e. gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUC). RESULTS Four trajectories were identified for the depressive symptoms: no symptoms (63.9%), depressive symptoms onset {incident increasing symptoms [new-onset increasing (16.8%)], chronic symptoms [slowly decreasing (12.5%), persistent high (6.8%)]}. Among the analyzed baseline variables, the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score, cognition, sleep time, self-reported memory were the top five important predictors across all trajectories. The mean AUCs of the three predictive models had a range from 0.661 to 0.892. CONCLUSIONS ML techniques can be robust in predicting depressive symptom onset and trajectories over a 7-year period with easily accessible sociodemographic and health information. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2031868.
Collapse
Affiliation(s)
- Shaowu Lin
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Yafei Wu
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Lingxiao He
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China.,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| |
Collapse
|
10
|
Lin S, Wu Y, Fang Y. A hybrid machine learning model of depression estimation in home-based older adults: a 7-year follow-up study. BMC Psychiatry 2022; 22:816. [PMID: 36544119 PMCID: PMC9768728 DOI: 10.1186/s12888-022-04439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Our aim was to explore whether a two-step hybrid machine learning model has the potential to discover the onset of depression in home-based older adults. METHODS Depression data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2,548) recruited in the China Health and Retirement Longitudinal Study were included in the current analysis. The long short-term memory network (LSTM) was applied to identify the risk factors of participants in 2015 utilizing the first 2 waves of data. Based on the identified predictors, three ML classification algorithms (i.e., gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUROC) to estimate the depressive outcome. RESULTS Time-varying predictors of the depression were successfully identified by LSTM (mean squared error =0.8). The mean AUCs of the three predictive models had a range from 0.703 to 0.749. Among the prediction variables, self-reported health status, cognition, sleep time, self-reported memory and ADL (activities of daily living) disorder were the top five important variables. CONCLUSIONS A two-step hybrid model based on "LSTM+ML" framework can be robust in predicting depression over a 5-year period with easily accessible sociodemographic and health information.
Collapse
Affiliation(s)
- Shaowu Lin
- grid.12955.3a0000 0001 2264 7233The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102 China ,grid.12955.3a0000 0001 2264 7233National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361102 China ,grid.12955.3a0000 0001 2264 7233Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, 361102 China
| | - Yafei Wu
- grid.12955.3a0000 0001 2264 7233The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102 China ,grid.12955.3a0000 0001 2264 7233National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361102 China ,grid.12955.3a0000 0001 2264 7233Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, 361102 China
| | - Ya Fang
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, 361102, China. .,National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, 361102, China. .,Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, 361102, China.
| |
Collapse
|
11
|
Vanwetswinkel F, Bruffaerts R, Arif U, Hompes T. The longitudinal course of depressive symptoms during the perinatal period: A systematic review. J Affect Disord 2022; 315:213-223. [PMID: 35803394 DOI: 10.1016/j.jad.2022.06.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perinatal Depression (PND) is one of the most common complications (10-20 %) during the perinatal period and its clinical course and phenotypes are still an area of research. It is becoming increasingly clear that pregnant women and mothers with depression are not a homogeneous clinical group. METHODS A systematic literature search in 4 databases revealed 359 studies, 33 relevant studies met the inclusion criteria. We only included studies with at least three assessment points in total. RESULTS Two to six trajectory classes were identified. A three trajectories solution was most observed. All the included studies reported a low symptom trajectory but ranged from 6.5 % to 92 %. The high-symptom group was in most of the studies the smallest subgroup (1.1 % - 14.6 %). Most of the studies described episodic trajectories of depressive symptoms during the peripartum. The most common risk factor associated with a high-symptom trajectory of depressive symptoms in our study was a history of depression. Important socio-demographic predictors were: young age, ethnicity, low maternal education, low income, single relationship status or relationship problems, unplanned or unintended pregnancy and experiencing high stress levels. LIMITATIONS The methodology and the observed PND trajectories of the included studies differed, which makes generalizability difficult in this review. CONCLUSIONS PND is a frequent but heterogeneous disorder. Globally, four major groups could be distinguished: low, medium, high and episodic trajectories. There is a need for consensus regarding which assessment instruments to use, validated cutoff scores and similar time points of assessment.
Collapse
Affiliation(s)
- Femke Vanwetswinkel
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium.
| | - Ronny Bruffaerts
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium
| | - Umesa Arif
- Biomedical Sciences, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Titia Hompes
- Adult Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Research Group Psychiatry, University of Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Yan P, Liu X, Xu J. Trajectories and Predictors of Symptoms of Depression in Chinese Women From Early Pregnancy to the Early Postpartum Period. J Obstet Gynecol Neonatal Nurs 2022; 51:577-589. [PMID: 35987260 DOI: 10.1016/j.jogn.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the trajectories and predictors of symptoms of depression in Chinese women from early pregnancy to 3 months after birth. DESIGN Prospective cohort study. SETTING Several maternal and child health care institutions and obstetric departments of general hospitals in Beijing, Jiangsu, Hunan, Sichuan, Shandong, Guangdong, and Shanxi provinces in China. PARTICIPANTS Chinese women (N = 667) during pregnancy and the postpartum period. METHODS From August 2019 to June 2020, participants from several tertiary hospitals in China who completed at least three measurements during early pregnancy to 3 months after birth (from time point 1 to time point 5) were included for data analysis. We used the self-administered basic information questionnaire and the Edinburgh Postnatal Depression Scale for follow-up. We used Mplus version 8.3 to construct the growth mixture modeling and SPSS version 25.0 to carry out logistic regression analysis. RESULTS We found three potential trajectories of symptoms of depression during pregnancy and the postpartum period: the down-then-up healthy group (Class 1, 68.5%), steady-growth moderate-risk group (Class 2, 27.5%), and up-then-down high-risk group (Class 3, 4.0%). Multinomial logistic regression analysis showed that being pregnant for the first time, being a company employee, being less satisfied with the living environment, and the occurrence of negative life events were significant predictors of the Class 2 trajectory, whereas younger age, being less satisfied with food, and the occurrence of negative life events were predictors of the Class 3 trajectory. CONCLUSION The trajectories of symptoms of depression during pregnancy and the postpartum period among Chinese women showed significant group heterogeneity. The trajectory categories were influenced not only by demographics and pregnancy-related factors but also by maternal subjective feelings.
Collapse
|
13
|
Shorey S, Loh DNL, Chan V, Chua C, Choolani MA. Parents' perceptions of antenatal educational programs: A meta-synthesis. Midwifery 2022; 113:103432. [PMID: 35907268 DOI: 10.1016/j.midw.2022.103432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Contents and mode of delivery of antenatal educational programs differed considerably. Yet there is a lack of high-level evidence about the delivery of these programs. OBJECTIVE We aimed to understand the experiences and needs of parents who have attended antenatal educational programs. DESIGN Six databases were searched from each database. Included studies were appraised using the Critical Appraisal Skills Program tool. Qualitative data were meta-summarized and meta-synthesized. FINDINGS Seventeen studies were included, and three themes were developed: (1) Contradicting views on antenatal educational programs, (2) Feeling 'well prepared' after attending the antenatal educational programs, and (3) Parents' expectations and way forward for the antenatal educational programs. DISCUSSION Findings revealed that the description of contents of antenatal educational programs needed to be more specific. Mindfulness strategies were well-received by parents in the included studies. Educators should take into account inclusivity and increase educational resources related to individual, cultural and community needs. Learning needs can be assessed before and after classes. Parents with specific needs that were not addressed should be identified and referred to the relevant professionals for continued support. More deliberate actions were needed during the programs to foster social and professional networks for attendees to support them throughout antenatal and postnatal periods. CONCLUSION We consolidated the experiences and needs of parents who have attended antenatal educational programs. Findings can help refine policies related to antenatal care to improve pregnancy, birth and parenthood experiences for both mothers and fathers.
Collapse
Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Doris Ngiuk Lan Loh
- Obstetrics and Gynecology Department, National University of Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Crystal Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Mahesh A Choolani
- Obstetrics and Gynecology Department, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| |
Collapse
|
14
|
Characterization of Depressive Symptom Trajectories in Women between Childbirth and Diagnosis. J Pers Med 2022; 12:jpm12040538. [PMID: 35455653 PMCID: PMC9030055 DOI: 10.3390/jpm12040538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
The inhomogeneity of postpartum mood and mother–child attachment was estimated from immediately after childbirth to 12 weeks postpartum in a cohort of 598 young mothers. At 3-week intervals, depressed mood and mother–child attachment were assessed using the EPDS and the MPAS, respectively. The diagnosis was based on clinical interviews at the end of the 12-week follow-up. The latent class mixed model estimated multiple distinct patterns in depressed mood and mother–child attachment. The baseline EPDS cluster contained 72% of the study population and showed low EPDS values during the follow-up period, while the five remaining clusters showed either deterioration or improvement of the EPDS levels. The majority of women with postpartum depression showed deteriorating, and the majority of adjustment disorder cases improving, behavior. While the cases with more pronounced EPDS values were found to constitute more homogeneous clusters in terms of diagnosis, subclinical or only temporarily increased EPDS levels represented less homogeneous clusters. Higher EPDS levels correlated with the higher risk factor profiles. The four MPAS/EPDS clusters demonstrated that higher EPDS lead to lower mother–child attachment, and vice versa.
Collapse
|
15
|
Advancing research on perinatal depression trajectories: Evidence from a longitudinal study of low-income women. J Affect Disord 2022; 301:44-51. [PMID: 34995707 DOI: 10.1016/j.jad.2022.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 01/02/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study aimed to describe and predict perinatal depression trajectories in a sample of low-income women from the first trimester of pregnancy to six months postpartum. METHODS The study sample consisted of 899 women in Wisconsin who received home visiting services. Eligible participants were screened for depressive symptoms by home visitors using the Edinburgh Postnatal Depression Scale at least three times across four time periods from the first trimester of pregnancy to six months postpartum. Growth Mixture Modeling was applied to identify distinct trajectory classes, and multinomial logistic regressions were performed to analyze predictors of class membership. RESULTS Mean depressive symptom scores in this racially/ethnically diverse sample of low-income women decreased significantly over time from a high of 8.1 at time1 to a low of 6.8 at time4. Four classes were identified, including a low-stable group (78.2% of sample), a high-stable group (10.6%) along with decreasing (7.1%) and increasing (4.1%) trajectories. Women with a history of abuse and mental health difficulties were more likely to be classified in the high-stable and decreasing depression groups than the low-stable group. Low social support was linked to an increasing trajectory that resulted in high levels of postpartum depression. CONCLUSIONS AND IMPLICATIONS Although most women exhibited stable and positive trajectories, more than one out of five presented with either persistently or intermittently high depression scores. Taken together, the findings underscore the importance of depression screening throughout the perinatal period and identifying factors that may be used to target resources to at-risk populations.
Collapse
|
16
|
Mesches GA, Ciolino JD, Stika CS, Sit DK, Zumpf K, Fisher S, Clark CT, George AL, Avram MJ, Rasmussen‐Torvik LJ, Erickson DL, Caritis S, Fischer D, Venkataramanan R, Costantine M, West H, Welch E, Clark S, Wisner KL, Gollan JK. Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Women. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:32-41. [PMID: 36254188 PMCID: PMC9558923 DOI: 10.1176/appi.prcp.20210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Tracking perinatal mood and anxiety disorders is championed by the American Psychiatric Association and the International Marcé Society for Perinatal Mental Health. We conducted this study to examine trajectories of monthly depressive and anxiety symptoms through pregnancy and postpartum. Methods This is a prospective longitudinal observational cohort study of pregnant women interviewed at baseline (≤18th gestational week), every four weeks through delivery and at 6 and 14 weeks postpartum at three urban academic medical centers (N = 85) and a single rural health center (N = 3) from 2016 to 2020. Pregnant women had at least one prior episode of major depressive disorder, were not in a current episode, and were treated with sertraline, fluoxetine, citalopram, or escitalopram. Of 192 women screened, 88 (46%) women enrolled, and 77 (88%) women completed the postpartum follow-up. Symptom trajectories were generated with scores from the Edinburgh Postnatal Depression Scale, the Quick Inventory of Depressive Symptoms, the Generalized Anxiety Disorder Scale, 7-item, and the Patient-Reported Outcomes Measurement Information System Global Health measure. A semi-parametric, group-based mixture model (trajectory analysis) was applied. Results Three relatively stable depression trajectories emerged, described as Minimal, Mild, and Subthreshold, in each group across pregnancy. Two of the four anxiety trajectories were stable, including Asymptomatic and Minimal, while the third, termed Breakthrough, was ascending with increasing symptoms and the fourth trajectory, described as Mild, had descending symptoms. Conclusions Screening for anxiety with depression for pregnant women will yield a comprehensive view of psychiatric symptoms and treatment targets in perinatal women.
Collapse
Affiliation(s)
- Gabrielle A. Mesches
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jody D. Ciolino
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Catherine S. Stika
- Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Dorothy K. Sit
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Katelyn Zumpf
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sheehan Fisher
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Crystal T. Clark
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Alfred L. George
- Department of PharmacologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Michael J. Avram
- Department of AnesthesiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Laura J. Rasmussen‐Torvik
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Daniel L. Erickson
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Steven Caritis
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of PittsburghMagee Womens HospitalPittsburghPennsylvaniaUSA
| | - Dawn Fischer
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of PittsburghMagee Womens HospitalPittsburghPennsylvaniaUSA
| | - Raman Venkataramanan
- Department of Pharmaceutical SciencesUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Maged Costantine
- Department of Maternal‐Fetal MedicineThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Holly West
- Department of OB/GYNUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Elizabeth Welch
- Department of OB/GYNUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Shannon Clark
- Department of OB/GYNUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jacqueline K. Gollan
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| |
Collapse
|
17
|
Molgora S, Saita E, Barbieri Carones M, Ferrazzi E, Facchin F. Predictors of Postpartum Depression among Italian Women: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031553. [PMID: 35162574 PMCID: PMC8835615 DOI: 10.3390/ijerph19031553] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Introduction: Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables. Methods: A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2–3 days, 3 months, 6 months, and 12 months postpartum. Results: Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months. Conclusion: Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.
Collapse
Affiliation(s)
- Sara Molgora
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
- Correspondence: ; Tel.: +39-0272342347; Fax: +39-0272345962
| | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
| | | | - Enrico Ferrazzi
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.C.); (E.F.)
- Department of Clinical Science and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Facchin
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
| |
Collapse
|
18
|
Kim O, Kim SY, Kim SS, Dan H, Kim B, Kim M, Pang Y. Depressive symptom trajectories and their relation to body mass index in women of child-bearing age: The Korea Nurses' Health Study. J Affect Disord 2021; 292:114-120. [PMID: 34118610 DOI: 10.1016/j.jad.2021.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study investigated the sub-trajectory groups of depressive symptoms in women of child-bearing age and the factors impacting latent class membership. Moreover, differences in body mass index (BMI) as an outcome variable were identified among the sub-trajectory groups. METHODS Data from the Korea Nurses' Health Study (KNHS) were analyzed, comprising that from 6,918 participants who filled out surveys during modules 1, 5, and 7. The growth mixture model with individually varying observation times was used to identify latent subgroups of depressive symptom trajectories. RESULTS Three classes of depressive symptom trajectories were identified: increasing over time, stable/low, and decreasing over time. Older participants had a higher probability of belonging to the stable/low class. Married participants were more likely to belong to the stable/low class than to the increasing over time class or decreasing over time class. Participants who worked shifts had a higher chance of belonging to the decreasing over time class than the stable/low class. There was a significant difference between mean BMI across latent classes in module 1 (χ2(df=2,N=6918)=155.16, p<0.001) and in module 7 (χ2(df=2,N=6918)=149.68, p<0.001). LIMITATIONS The findings of this study should not be generalized to all women of childbearing age, because the study population only included nurses. CONCLUSIONS The results suggest that interventions designed to manage depressive symptoms in women who are younger, unmarried, and who perform shift work may be beneficial. This study identified a relationship between increasing severity of depressive symptoms and increasing BMI.
Collapse
Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, South Korea
| | - Su-Young Kim
- Department of Psychology, Ewha Womans University, Seoul, South Korea
| | - Suk-Sun Kim
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, South Korea
| | - Hyunju Dan
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, South Korea
| | - Bohye Kim
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, South Korea
| | - Minjoo Kim
- Department of Psychology, Ewha Womans University, Seoul, South Korea
| | - Yanghee Pang
- College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, South Korea.
| |
Collapse
|
19
|
Nowland R, Thomson G, McNally L, Smith T, Whittaker K. Experiencing loneliness in parenthood: a scoping review. Perspect Public Health 2021; 141:214-225. [PMID: 34286652 PMCID: PMC8580382 DOI: 10.1177/17579139211018243] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Chronic loneliness is experienced by around a third of parents, but there is no comprehensive review into how, why and which parents experience loneliness. This scoping review aimed to provide insight into what is already known about parental loneliness and give directions for further applied and methodological research. METHODS Searches for peer-reviewed articles were undertaken in six databases: PsycINFO, Medline, CINAHL, Embase, Web of Science and Scopus, during May 2019 to February 2020. We searched for English studies which examined loneliness experienced during parenthood, including studies that involved parents with children under 16 years and living at home and excluding studies on pregnancy, childbirth or postbirth hospital care. RESULTS From 2566 studies retrieved, 133 were included for analysis. Most studies (n = 80) examined the experience of loneliness in specific groups of parents, for example, teenage parents, parents of a disabled child. Other studies examined theoretical issues (n = 6) or health and wellbeing impacts on parents (n = 16) and their offspring (n = 17). There were 14 intervention studies with parents that measured loneliness as an outcome. Insights indicate that parental loneliness may be different to loneliness experienced in other cohorts. There is evidence that parental loneliness has direct and intergenerational impacts on parent and child mental health. Some parents (e.g. with children with chronic illness or disability, immigrant or ethnic minority parents) also appear to be at increased risk of loneliness although evidence is not conclusive. CONCLUSION This work has identified key gaps with further international, comparative and conceptual research needed.
Collapse
Affiliation(s)
- R Nowland
- School of Community Health and Midwifery, University of Central Lancashire Brooke Building, Preston PR2 1HE, UK
| | - G Thomson
- University of Central Lancashire, Preston, UK
| | - L McNally
- University of Central Lancashire, Preston, UK
| | - T Smith
- University of Central Lancashire, Preston, UK
| | - K Whittaker
- University of Central Lancashire, Preston, UK
| |
Collapse
|
20
|
Ladyman C, Gander P, Huthwaite M, Sweeney B, Signal TL. Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women. Behav Sleep Med 2021; 19:427-444. [PMID: 32497446 DOI: 10.1080/15402002.2020.1772265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.
Collapse
Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| |
Collapse
|
21
|
Wojciechowski T. Presentation of Borderline Personality Disorder Symptoms in Adulthood: Development of Depression Mediates the Effect of Childhood and Adolescent Exposure to Violence. J Nerv Ment Dis 2021; 209:283-290. [PMID: 33346599 DOI: 10.1097/nmd.0000000000001291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Past research has linked the development of borderline personality disorder to earlier exposure to violence. However, the causal link by which this relationship exists has not yet been fully identified. The present study sought to examine how exposure to violence predicted heterogeneity in the development of depressive systems and results in the arousal of borderline personality disorder symptoms in adulthood. The Pathways to Desistance data were used in the analyses. This data set consisted of the responses of 1354 juvenile offenders followed across 7 years. Group-based trajectory modeling was used to identify latent trajectories of depressive symptoms. Ordinary least squares regression was used to model covariate effects on borderline personality disorder symptoms in adulthood. Results indicated that a three-group depression trajectory model best fit the data. Direct victimization early in life was associated with increased borderline personality disorder symptoms in adulthood. When trajectory group assignment was accounted for in the model, the relationship between direct victimization and borderline personality disorder symptoms was attenuated by around 30%. Implications are discussed.
Collapse
|
22
|
Trajectories of Depressive Symptoms and Anxiety during Pregnancy and Associations with Pregnancy Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052733. [PMID: 33800371 PMCID: PMC7967460 DOI: 10.3390/ijerph18052733] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022]
Abstract
The purposes of this study were to investigate the trajectory groups of depressive symptoms and anxiety in women during pregnancy and to identify the factors associated with those groups. Participants were recruited from the outpatient clinic of a women's health hospital in Seoul, Korea. Pregnant women (n = 136) completed a survey questionnaire that included questions on depressive symptoms, anxiety, and pregnancy stress; additionally, their saliva was tested for cortisol hormone levels three times during their pregnancies. The group-based trajectory modeling approach was used to identify latent trajectory groups. Ordinal logistic regressions were used to explore the association of latent trajectory groups with sociodemographic factors and pregnancy stress. Three trajectory groups of depressive symptoms were identified: low-stable (70%), moderate-stable (25%), and increased (5%). Four trajectory groups of anxiety were identified: very low-stable (10%), low-stable (67%), moderate-stable (18%), and high-stable (5%). The only factor associated with both the depressive symptoms and anxiety trajectory groups was pregnancy stress (p < 0.001). Most participants showed stable emotional status; however, some participants experienced higher levels of depressive symptoms and anxiety related to higher pregnancy stress. These pregnant women may need additional care from healthcare providers to promote their wellbeing during pregnancy.
Collapse
|
23
|
Yu M, Li H, Xu DR, Wu Y, Liu H, Gong W. Trajectories of perinatal depressive symptoms from early pregnancy to six weeks postpartum and their risk factors-a longitudinal study. J Affect Disord 2020; 275:149-156. [PMID: 32734901 DOI: 10.1016/j.jad.2020.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies explored trajectories of depressive symptoms from early pregnancy and covered the whole perinatal period. This study aimed to explore the trajectories of perinatal depressive symptoms, their heterogeneity of onsets and peaks, and relations to demographic and psychological factors. METHOD A longitudinal study was conducted at two hospitals in China amongst 1,126 participants. Perinatal depression was measured using the Edinburgh Postnatal Depression Scale. Demographic and psychological factors were collected by self-developed questionnaire and Generalized Anxiety Disorder-7. Women completing at least three depression screens (n = 879) were included. Latent Growth Curve Model and Growth Mixture Model were performed to identify the depression trajectories and logistic regression was used to analyse factors of trajectories. RESULTS Three trajectories were identified: 90.0% of women never presented with depressive symptoms ("Low-throughout"); 5.1% presented with depressive symptoms mainly during the antenatal period ("Antenatal-high"); 4.9% presented with depressive symptoms mainly during the postpartum period ("Postpartum-high"). 52.4% of women experienced their first depressive symptoms during early pregnancy. Suffering from anxiety and being unsatisfied with their marriage were associated with the "Antenatal-high" and "Postpartum-high" trajectories, respectively. LIMITATIONS Response rate was not high. We also do not have information on clinical diagnoses or changes in some variables over time. CONCLUSIONS We identified three trajectories and heterogeneity existed concerning the timing of their peaks. Women should be considered for depression screening and intervention in early pregnancy. Factors associated with each trajectory were different, raising the potential of individualized intervention to reduce the occurrence of depression.
Collapse
Affiliation(s)
- Min Yu
- Xiangya School of Public Health, Central South University, Hunan, China
| | - Hui Li
- School of Mathematics and Statistics, University of Birmingham, UK
| | - Dong Roman Xu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangdong, China
| | - Yinglan Wu
- Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Hospital, Hunan, China
| | - Hua Liu
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital in Ziyang district of Yiyang city, Hunan, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Hunan, China.
| |
Collapse
|
24
|
Asselmann E, Kunas SL, Wittchen HU, Martini J. Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study. PLoS One 2020; 15:e0237609. [PMID: 32833975 PMCID: PMC7446870 DOI: 10.1371/journal.pone.0237609] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background The role of maternal personality and perceived social support for peripartum changes in psychopathological symptoms remains unresolved. Methods In a regional-epidemiological sample of 306 women, depressive, anxiety, and stress symptoms were assessed three times during pregnancy and three times after delivery with the 21-item version of the Depression Anxiety Stress Scale. In pregnancy, the Big Five personality traits and perceived social support were assessed with the short version of the Big Five Inventory and the Social Support Questionnaire. Results Multilevel analyses revealed that depressive (b = -0.055) and stress (b = -0.047) symptoms decreased from early to late pregnancy. After delivery, anxiety symptoms were lower (two months postpartum: b = -0.193; four/ 16 months postpartum: b = -0.274), but stress symptoms were higher (two months postpartum: b = 0.468; four/ 16 months postpartum: b = 0.320) than during pregnancy. Across the peripartum period, more conscientious and more extraverted women experienced lower depressive and stress symptoms (b = -0.147 to -0.177), and more emotionally stable women experienced lower depressive, anxiety, and stress symptoms (b = -0.294 to -0.415). More emotionally stable women more strongly increased in anxiety during pregnancy (b = 0.019), and more extraverted women less strongly increased in depression after delivery (b = -0.010). Moreover, peripartum depressive, anxiety, and stress symptoms were lower in women with higher perceived social support (b = -0.225 to -0.308). Conclusions Less emotionally stable, less conscientious, and less extraverted women and women with lower perceived social support seem to be at increased risk for peripartum psychopathological symptoms and might thus particularly profit from targeted prevention.
Collapse
Affiliation(s)
- Eva Asselmann
- Department of Psychology, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- * E-mail:
| | - Stefanie L. Kunas
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians Universität, Munich, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
25
|
Jacques N, Mesenburg MA, Matijasevich A, Domingues MR, Bertoldi AD, Stein A, Silveira MF. Trajectories of maternal depressive symptoms from the antenatal period to 24-months postnatal follow-up: findings from the 2015 Pelotas birth cohort. BMC Psychiatry 2020; 20:233. [PMID: 32408866 PMCID: PMC7222527 DOI: 10.1186/s12888-020-02533-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal depression may be chronic and recurrent, with negative effects both on the health of mothers and children. Many studies have shown trajectories of postnatal depressive symptoms but few studies in low- and middle-income countries have evaluated the trajectories of depressive symptoms starting during pregnancy. This study aims to identify the different trajectories of depressive symptoms among mothers in the Pelotas 2015 birth cohort, from pregnancy to the second year of the child's life. METHODS This study used data from the 2015 Pelotas Birth Cohort, a longitudinal study of all live births occurred in 2015 in Pelotas, Brazil. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers who completed the EPDS on at least three follow-up visits beginning to the antenatal follow-up visit were included in the analyses. The trajectory of maternal depressive symptoms was estimated through group-based trajectory modeling. RESULTS A total of 3040 women were included in the present analysis. We identified five groups of maternal depressive symptoms trajectories, with 23.4% of the mothers presenting persistent depressive symptoms and 3.9% showing chronic high depressive symptoms throughout the study period. The probability of having persistent depressive symptoms increased among mothers with greater socioeconomic vulnerability. CONCLUSIONS This study shown the persistence of maternal depressive symptoms since pregnancy until 2 years postnatal. Additionally, alongside the known risk factors, pre-gestational depression and antenatal depressive symptoms are important risk factors for the persistence and severity of depressive symptoms. These findings support the need to provide mental health evaluation and care for women from pregnancy to the late postnatal period.
Collapse
Affiliation(s)
- Nadège Jacques
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, nº 1160 3º andar, Pelotas, CEP 96020-220, Rio Grande Do Sul, Brazil.
| | - Marilia Arndt Mesenburg
- grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, nº 1160 3º andar, Pelotas, CEP 96020-220 Rio Grande Do Sul Brazil
| | - Alicia Matijasevich
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Avenida Dr. Arnaldo, 455, 2º andar, sala 2166, São Paulo, CEP 1246-903 Brazil
| | - Marlos Rodrigues Domingues
- grid.411221.50000 0001 2134 6519College of Physical Education, Federal University of Pelotas, R. Luís de Camões, 625-Três Vendas, Pelotas, - RS, CEP 96055-630 Pelotas, Rio Grande Do Sul Brazil
| | - Andréa Dâmaso Bertoldi
- grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, nº 1160 3º andar, Pelotas, CEP 96020-220 Rio Grande Do Sul Brazil
| | - Alan Stein
- grid.4991.50000 0004 1936 8948Institutional address: Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX UK
| | - Mariangela Freitas Silveira
- grid.411221.50000 0001 2134 6519Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, nº 1160 3º andar, Pelotas, CEP 96020-220 Rio Grande Do Sul Brazil
| |
Collapse
|
26
|
Chow A, Dharma C, Chen E, Mandhane PJ, Turvey SE, Elliott SJ, Becker AB, Subbarao P, Sears MR, Kozyrskyj AL. Trajectories of Depressive Symptoms and Perceived Stress From Pregnancy to the Postnatal Period Among Canadian Women: Impact of Employment and Immigration. Am J Public Health 2020; 109:S197-S204. [PMID: 31242008 DOI: 10.2105/ajph.2018.304624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives. To identify trajectory patterns of maternal depressive symptoms and perceived stress from midpregnancy to 2 years postpartum and determine relationships with selected sociodemographic factors including income, education, immigration, and postpartum employment. Methods. Pregnant women (n = 3307) recruited from the general population in 4 regions in Canada provided 6 waves of data from pregnancy to 2 years postpartum. The study was conducted from 2009 to 2015. Results. We determined 5 trajectory groups distinguished by time and magnitude for both depressive symptoms and perceived stress. Immigrants living in Canada for more than 5 up to 10 years, but not more recent arrivals, were at higher risk for persistent stress and depression independent of income status. Being employed at 1 year postpartum was associated with a lower likelihood of postpartum depression and perceived stress, while mothers reporting work exhaustion were substantially more likely to experience persistent depression and stress. Conclusions. The study highlighted the heterogeneous nature of depressive symptoms and perceived stress. Targeting interventions toward women 5 to 10 years after immigration and those experiencing exhaustion from postpartum work may be particularly beneficial.
Collapse
Affiliation(s)
- Angela Chow
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Christoffer Dharma
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Edith Chen
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Piushkumar J Mandhane
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stuart E Turvey
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Susan J Elliott
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Allan B Becker
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Padmaja Subbarao
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Malcolm R Sears
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Anita L Kozyrskyj
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| |
Collapse
|
27
|
Asselmann E, Kunas SL, Wittchen HU, Martini J. Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy. J Affect Disord 2020; 263:480-490. [PMID: 31969281 DOI: 10.1016/j.jad.2019.11.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet. METHODS A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery. RESULTS Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy. LIMITATIONS Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased. CONCLUSIONS Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.
Collapse
Affiliation(s)
- E Asselmann
- Department of Psychology, Faculty of Life Sciences, Humboldt University of Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - S L Kunas
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
28
|
Choe DE, McDonough SC, Sameroff AJ, Lawrence AC. Postnatal trajectories of maternal depressive symptoms: Postpartum antecedents and differences in toddler adjustment. Infant Ment Health J 2020; 41:278-293. [PMID: 32057132 DOI: 10.1002/imhj.21843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infants are uniquely vulnerable to maternal depression's noxious effects, but few longitudinal studies have tried to identify discrete postnatal trajectories of maternal depressive symptoms (MDS) beginning in infancy. This study extends evidence of heterogeneous change in postnatal MDS by examining their cross-contextual antecedents in infancy and their consequences for children's early behavior problems and language skills in late toddlerhood. A community sample of mother-child dyads (N = 235, 72% Caucasian) was assessed when children were 7, 15, and 33 months old. Mothers reported their socioeconomic status (SES), social support, marital relationship quality, family dysfunction, parenting stress, and infants' functional regulatory problems at 7 months postpartum, and children's internalizing and externalizing symptoms at 33 months. Children completed a receptive vocabulary assessment at 33 months in the lab. Latent class growth analysis identified three postnatal MDS trajectory classes that fit the data best: low-decreasing, moderate, and increasing. Psychosocial measures at seven months postpartum primarily predicted membership to these postnatal trajectory classes, which subsequently differed in children's internalizing, externalizing, and receptive vocabulary in late toddlerhood, controlling for family SES and functional regulatory problems in infancy. We discuss salient antecedents and consequences of postnatal depression for mothers and their offspring.
Collapse
Affiliation(s)
- Daniel Ewon Choe
- Department of Human Ecology, University of California, Davis, California
| | - Susan C McDonough
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - Arnold J Sameroff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - Amanda C Lawrence
- Department of Human Ecology, University of California, Davis, California
| |
Collapse
|
29
|
Lallukka T, Mekuria GB, Nummi T, Virtanen P, Virtanen M, Hammarström A. Co-occurrence of depressive, anxiety, and somatic symptoms: trajectories from adolescence to midlife using group-based joint trajectory analysis. BMC Psychiatry 2019; 19:236. [PMID: 31370894 PMCID: PMC6670180 DOI: 10.1186/s12888-019-2203-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Co-occurrence of mental and somatic symptoms is common, and recent longitudinal studies have identified single trajectories of these symptoms, but it is poorly known whether the symptom trajectories can also co-occur and change across the lifespan. We aimed to examine co-occurring symptoms and their joint trajectories from adolescence to midlife. METHODS Longitudinal data were derived from Northern Sweden, where 506 girls and 577 boys aged 16 years participated at baseline in 1981 (99.7% of those initially invited), and have been followed up in four waves until the age of 43. Survey data were collected about depressive, anxiety, and somatic symptoms. Potential joint development of this three-component symptom set was examined with multiple response trajectory analysis, a method that has not been previously used to study co-occurrence of these symptoms. RESULTS We identified a five trajectory solution as the best: "very low" (19%), "low" (31%), "high" (22%), "late sharply increasing" (16%) and a "very high increasing" (12%). In the "late sharply increasing" and "very high increasing" groups the scores tended to increase with age, while in the other groups the levels were more stable. Overall, the results indicated that depressive, anxiety, and somatic symptoms co-exist from adolescence to midlife. CONCLUSIONS The multiple response trajectory analysis confirmed high stability in the co-occurrence of depressive, anxiety, and somatic symptoms from adolescence to midlife. Clinicians should consider these findings to detect symptoms in their earliest phase in order to prevent the development of co-occurring high levels of symptoms.
Collapse
Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland. .,Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Gashaw B. Mekuria
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, Faculty of Social Sciences, Tampere, Finland
| | - Tapio Nummi
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, School of Natural Sciences, Tampere, Finland
| | - Pekka Virtanen
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, Faculty of Social Sciences, Tampere, Finland
| | - Marianna Virtanen
- 0000 0001 0726 2490grid.9668.1School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Anne Hammarström
- 0000 0001 1034 3451grid.12650.30Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden ,0000 0004 1936 9377grid.10548.38Stress Research Institute, Stockholm University, Sweden and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
30
|
Dekel S, Ein-Dor T, Ruohomäki A, Lampi J, Voutilainen S, Tuomainen TP, Heinonen S, Kumpulainen K, Pekkanen J, Keski-Nisula L, Pasanen M, Lehto SM. The dynamic course of peripartum depression across pregnancy and childbirth. J Psychiatr Res 2019; 113:72-78. [PMID: 30921631 DOI: 10.1016/j.jpsychires.2019.03.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations. METHODS We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables. RESULTS Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class. CONCLUSION The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.
Collapse
Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Tsachi Ein-Dor
- School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel
| | - Aleksi Ruohomäki
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Jussi Lampi
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland; Social and Health, City of Kuopio, Kuopio, Finland
| | - Sari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Kirsti Kumpulainen
- Institute of Clinical Medicine, Child Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Department of Health Sciences, Clinical Medicine University of Eastern Finland, Kuopio, Finland
| | - Markku Pasanen
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
31
|
Dharma C, Lefebvre DL, Lu Z, Lou WYW, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Azad MB, Chen E, Elliott SJ, Kozyrskyj AL, Sears MR, Subbarao P. Risk for Maternal Depressive Symptoms and Perceived Stress by Ethnicities in Canada: From Pregnancy Through the Preschool Years. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:190-198. [PMID: 30068224 PMCID: PMC6405811 DOI: 10.1177/0706743718792190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Past cross-sectional studies have reported that mothers from ethnic minorities experience higher levels of prenatal and post-partum psychosocial distress compared with mothers from ethnic majorities. However, no studies have examined how the pattern varies longitudinally in a Canadian population of heterogeneous ethnicity. METHODS We analyzed data from 3,138 mothers participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study, a longitudinal multi-center study incorporating 10 distinct waves of psychosocial data collection from pregnancy until the index child was aged 5 y. Maternal self-identified ethnicity was grouped as White Caucasian, First Nations, Black, Southeast Asian, East Asian, South Asian, Middle Eastern, Hispanic and mixed ethnicity. We performed a multi-level regression to determine whether mothers of specific minority ethnicities were more likely to experience higher levels of distress (i.e. depressive symptoms and perceived stress) compared to white Caucasian mothers. RESULTS Mothers self-identifying as Black or First Nations had consistently higher distress scores than mothers from other ethnicities across all data collection times. After adjusting for relevant variables (history of depression, education, household income, marital status, and social support), First Nations mothers had a 20% increase in the mean scores of depressive symptoms compared to White Caucasian Mothers. CONCLUSIONS Increased levels of perinatal and post-partum distress were seen in only some ethnic minority groups. Studies should avoid collapsing all categories into ethnic minority or majority and may need to consider how ethnicity interacts with other sociodemographic factors such as poverty.
Collapse
Affiliation(s)
| | | | - Zihang Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Wendy Y. W. Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto,
Canada
| | - Allan B. Becker
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | | | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver,
Canada
| | - Theo J. Moraes
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, University of Manitoba,
Winnipeg, Canada
| | - Edith Chen
- Department of Psychology, Northwestern University, IL, USA
- Institute for Policy Research, Northwestern University, IL, USA
| | - Susan J. Elliott
- Department of Geography and Environmental Management, University of
Waterloo, Ontario, Canada
| | | | | | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto & Hospital for Sick
Children, Toronto, Canada
| |
Collapse
|
32
|
Wikman A, Axfors C, Iliadis SI, Cox J, Fransson E, Skalkidou A. Characteristics of women with different perinatal depression trajectories. J Neurosci Res 2019; 98:1268-1282. [DOI: 10.1002/jnr.24390] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/07/2018] [Accepted: 01/09/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Anna Wikman
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Cathrine Axfors
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Department of Neuroscience, Psychiatry Uppsala University Uppsala Sweden
| | - Stavros I Iliadis
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - John Cox
- Keele University Keele United Kingdom
| | - Emma Fransson
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
- Department of Microbiology, Tumour and Cell biology Karolinska Institute Stockholm Sweden
| | - Alkistis Skalkidou
- Department of Women’s and Children’s Health Uppsala University Uppsala Sweden
| |
Collapse
|
33
|
Ahmed A, Bowen A, Feng CX, Muhajarine N. Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpartum and their prenatal predictors. BMC Pregnancy Childbirth 2019; 19:26. [PMID: 30642277 PMCID: PMC6332639 DOI: 10.1186/s12884-019-2177-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/04/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Maternal depression and anxiety have distinct constellations of symptom trajectories, which are associated with factors that may vary between different groups of women. The aim of this study was to identify subgroups of women who exhibit unique longitudinal trajectory patterns of depressive and anxiety symptoms from pregnancy to 5 years postpartum and the antenatal predictors associated with these maternal groups. METHODS The study used a longitudinal data collected from 615 women in Saskatchewan from pregnancy to 5 years postpartum. Semiparametric group-based models were used to identify latent maternal depressive and anxiety trajectory groups. Multinomial logit models were then used to assess the association between maternal characteristics and the identified latent trajectory groups. RESULTS We identified four trajectory groups of maternal depressive symptoms: low-stable (35%); moderate-stable (54%); moderate-increasing (5%); and high-decreasing (6%), and three trajectory groups of maternal anxiety symptoms: very low-stable (13%); low-stable (58%); and moderate-stable (29%). We also identified several risk factors, most notably history of depression and stress, that were significantly associated with these trajectories. CONCLUSION History of depression and increased stress are significant risk factors that can be identified during regular perinatal visits; therefore, clinicians should inquire about these risk factors to identify women at high risk of ongoing depression or anxiety.
Collapse
Affiliation(s)
- Asma Ahmed
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue W, Room 27, Montreal, Quebec H3A 1A2 Canada
| | - Angela Bowen
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 4246, Saskatoon, Saskatchewan S7N 2Z4 Canada
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3338, Saskatoon, Saskatchewan S7N 2Z4 Canada
| | - Nazeem Muhajarine
- College of Medicine, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3246, Saskatoon, Saskatchewan S7N 2Z4 Canada
| |
Collapse
|
34
|
Hollins Martin CJ, Anderson L, Martin CR. A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother'). J Reprod Infant Psychol 2018; 37:224-241. [PMID: 30554526 DOI: 10.1080/02646838.2018.1556786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.
Collapse
Affiliation(s)
- Caroline J Hollins Martin
- a Maternal Health, School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Lara Anderson
- b School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Colin R Martin
- c Perinatal Mental Health , Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull , UK
| |
Collapse
|
35
|
Luoma I, Korhonen M, Puura K, Salmelin RK. Maternal loneliness: concurrent and longitudinal associations with depressive symptoms and child adjustment. PSYCHOL HEALTH MED 2018; 24:667-679. [PMID: 30514104 DOI: 10.1080/13548506.2018.1554251] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Loneliness has potentially adverse effects on health and is often connected with depression, while maternal depression has been shown to have a harmful effect on many indicators of children's socioemotional outcomes. The prevalence of loneliness among first-time mothers and its associations with depressive symptoms, background factors, and child outcomes in middle childhood and adolescence were investigated in this longitudinal study. A sample of 122 mother-child dyads was collected from maternal health clinics in Tampere, Finland. The mothers reported their feelings of loneliness at three time points: during pregnancy and when their firstborn child was 8-9 and 16-17 years old. Maternal depressive symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS) at the same time points. The children's internalizing and externalizing problems were assessed using the Child Behavior Checklist (CBCL) and Youth Self Report (YSR) questionnaires. Some 34-38% of the mothers reported loneliness at the different study points. Maternal loneliness showed associations with dissatisfaction with life and the pair relationship, and with the presence of depressive symptoms. The mother's prenatal loneliness predicted the child's internalizing problems in adolescence. Interventions aimed at relieving loneliness should be provided for mothers at all stages of motherhood.
Collapse
Affiliation(s)
- Ilona Luoma
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Child Psychiatry , Tampere University Hospital , Tampere , Finland.,c Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland.,d Department of Paediatrics , Kuopio University Hospital , Kuopio , Finland
| | - Marie Korhonen
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,e Department of Child Psychiatry , Helsinki University Hospital , Helsinki , Finland
| | - Kaija Puura
- a Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.,b Department of Child Psychiatry , Tampere University Hospital , Tampere , Finland
| | - Raili K Salmelin
- b Department of Child Psychiatry , Tampere University Hospital , Tampere , Finland.,f Faculty of Social Sciences , University of Tampere , Tampere , Finland
| |
Collapse
|
36
|
Drozd F, Haga SM, Valla L, Slinning K. Latent trajectory classes of postpartum depressive symptoms: A regional population-based longitudinal study. J Affect Disord 2018; 241:29-36. [PMID: 30096589 DOI: 10.1016/j.jad.2018.07.081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/29/2018] [Accepted: 07/30/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE This study aimed to (a) assess trajectories of women's depressive symptoms during the first year postpartum to (b) identify potential unobserved classes of women as defined by their trajectories, (c) identify antepartum and early postpartum risk factors associated with trajectory classes, and (d) examine the association between trajectory classes and counselling during the postpartum period. METHODS Data on depressive symptoms, using the Edinburgh Postnatal Depression Scale (EPDS), were collected from 1374 women across nine Norwegian well-baby clinics at 1.5, 4, 6, and 12 months postpartum. Well-baby clinics offer universal, free services to all families living in the municipality. Thus, there were no specific exclusion criteria for this study. All clinics had implemented the Edinburgh-method which combines screening for PPD, using the EPDS, with supportive counselling. RESULTS Analyses showed that depressive symptoms decreased initially, followed by a flattening in symptoms at 6 months. Mixture analyses, however, identified two classes of women with distinct trajectories; (1) a low-risk (n = 1249, 91%) and (2) a high-risk group (n = 119, 9%). Complications after birth, elevated prenatal depressive symptoms, previous or current mental illness, and gestational week, predicted trajectory class membership. Women in the high-risk group were more likely to receive counselling than low-risk women. LIMITATIONS Women had higher educational level than the general population and one of the municipalities did not have a 12-months routine consultation. CONCLUSION Findings suggest heterogeneity among women in their depressive symptoms during the first year postpartum with a distinct set of risk factors associated with high-risk women. This has implications for the prevention and follow-up of women during pregnancy and the first year after childbirth.
Collapse
Affiliation(s)
- Filip Drozd
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lisbeth Valla
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
37
|
Carroll M, Downes C, Gill A, Monahan M, Nagle U, Madden D, Higgins A. Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study. Midwifery 2018; 64:29-37. [DOI: 10.1016/j.midw.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/15/2018] [Accepted: 05/12/2018] [Indexed: 01/07/2023]
|
38
|
Denckla CA, Mancini AD, Consedine NS, Milanovic SM, Basu A, Seedat S, Spies G, Henderson DC, Bonanno GA, Koenen KC. Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender. Psychol Med 2018; 48:1139-1147. [PMID: 28889814 PMCID: PMC5845817 DOI: 10.1017/s0033291717002549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. METHODS The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. RESULTS Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. CONCLUSIONS There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.
Collapse
Affiliation(s)
- C. A. Denckla
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | | | | | | | - A. Basu
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S. Seedat
- Stellenbosch University, Cape Town, South Africa
| | - G. Spies
- Stellenbosch University, Cape Town, South Africa
| | | | - G. A. Bonanno
- Teacher’s College, Columbia University, New York City, USA
| | - K. C. Koenen
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| |
Collapse
|
39
|
The effects of trauma on perinatal depression: Examining trajectories of depression from pregnancy through 24 months postpartum in an at-risk population. J Affect Disord 2017; 218:269-276. [PMID: 28477506 DOI: 10.1016/j.jad.2017.04.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/24/2017] [Accepted: 04/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research suggests that trauma exposure is associated with perinatal depression; however, little is known about the nature of the relation between trauma history and trajectory of depression, as well as the predictive power of trauma history beyond other risk factors. Additionally, more research is needed in at-risk samples that are likely to experience severe traumatic exposure. METHODS Secondary data analysis was conducted using demographic and depression data from the Healthy Start and Empowerment Family Support programs in Des Moines, Iowa. Hierarchical linear modeling was used to examine trajectories of perinatal depressive symptoms, from pregnancy to 24 months postpartum, and clarify whether trauma exposure, relationship status, and substance use uniquely contribute to trajectories of symptoms over time. RESULTS On average, depressive symptoms decreased from pregnancy to 24 months postpartum; however, trajectories varied across women. Single relationship status, substance use, and trauma history were each predictors of higher depression levels at several points in time across the observed perinatal period. Single relationship status was also associated with decline in depressive symptoms followed by a rebound of symptoms at 22 months postpartum. LIMITATIONS These data were not collected for research purposes and thus did not undergo the rigorous data collection strategies typically implemented in an established research study. CONCLUSIONS History of trauma, substance use and single relationship status represent unique risk factors for perinatal depression. For single women, depressive symptoms rebound late in the postpartum period. Single women are at greater risk for substance use and traumatic exposure and represent a sample with cumulative risk. Eliciting social support may be an important intervention for women presenting with these risk factors.
Collapse
|
40
|
Kingsbury AM, Plotnikova M, Clavarino A, Mamun A, Najman JM. Social adversity in pregnancy and trajectories of women's depressive symptoms: A longitudinal study. Women Birth 2017; 31:52-58. [PMID: 28711396 DOI: 10.1016/j.wombi.2017.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 04/05/2017] [Accepted: 06/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sound evidence has linked the experience of adversity with depression. Less is known about this association over time. AIM The aim of this study is to determine whether or not social adversity experienced by pregnant women is associated with their patterns of depressive symptoms over their reproductive life course. METHODS Data were obtained from a cohort of women collected at their first obstetrical clinic visit of an index pregnancy (time-point 1) and at a further six time-points to 27 years following the birth. Latent Class Growth Modelling was used to estimate trajectories of women's depressive symptoms over this time period. Logistic regression modelling determined the prospective association between measures of adversity in pregnancy and 27-year postpartum depression trajectories, controlling for potential confounders. FINDINGS Experiencing financial problems, housing problems, serious disagreements with partners and with others, and experiencing serious health problems in pregnancy were associated with membership of high and middle depression trajectories over the 27 years. Having someone close die or have a serious illness was associated with the high depression trajectory only. Younger maternal age and low family-income at first clinic visit were also associated with an increased risk of women's membership of both high and middle depression trajectories. CONCLUSIONS Experiencing adversity during pregnancy predicts subsequent patterns of maternal depression over an extended period of women's reproductive life course. It is not clear whether women's experiences of adversity during pregnancy were causally associated with subsequent depression or whether there are other explanations of the observed association.
Collapse
Affiliation(s)
- Ann M Kingsbury
- The University of Queensland, School of Public Health, Herston, Brisbane, Queensland 4006, Australia.
| | - Maria Plotnikova
- The University of Queensland, School of Public Health, Herston, Brisbane, Queensland 4006, Australia.
| | - Alexandra Clavarino
- The University of Queensland, School of Pharmacy, Brisbane, Queensland, 4102, Australia.
| | - Abullah Mamun
- The University of Queensland, School of Public Health, Herston, Brisbane, Queensland 4006, Australia.
| | - Jake M Najman
- The University of Queensland, Schools of Public Health and Social Sciences, Herston, Brisbane, Queensland 4006, Australia.
| |
Collapse
|
41
|
Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. Soc Psychiatry Psychiatr Epidemiol 2017; 52:815-828. [PMID: 28451700 DOI: 10.1007/s00127-017-1387-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. METHOD Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum. RESULTS Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum. CONCLUSIONS This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.
Collapse
|
42
|
Santos H, Tan X, Salomon R. Heterogeneity in perinatal depression: how far have we come? A systematic review. Arch Womens Ment Health 2017; 20:11-23. [PMID: 27796597 PMCID: PMC5507213 DOI: 10.1007/s00737-016-0691-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/18/2016] [Indexed: 01/18/2023]
Abstract
Despite perinatal depression (PND) being a common mental disorder affecting pregnant women and new mothers, limited attention has been paid to the heterogeneous nature of this disorder. We examined heterogeneity in PND symptom profiles and symptom trajectories. Literature searches revealed 247 studies, 23 of which were included in the final review. The most common statistical approaches used to explore symptom and trajectory heterogeneity were latent class model and growth mixture model. All but one study examined PND symptom trajectories and provided collective evidence of at least three heterogeneous patterns: low, medium, or chronic-high symptom levels. Social and psychological risk factors were the most common group of predictors related to a higher burden (high sum of score) of depressive symptoms. These studies were consistent in reporting poorer health outcomes for children of mothers assigned to high burden symptom trajectories. Only one study explored heterogeneity in symptom profile and was the only one to describe the specific constellations of depressive symptoms related to the PND heterogeneous patterns identified. Therefore, there is limited evidence on the specific symptoms and symptom configurations that make up PND heterogeneity. We suggest directions for future research to further clarify the PND heterogeneity and its related mechanisms.
Collapse
Affiliation(s)
- Hudson Santos
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB# 7460, Chapel Hill, NC, 27599, USA.
| | - Xianming Tan
- Department of Biostatistics, Lineberger Comprehensive Cancer Center, and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7295, Chapel Hill, NC, 27599, USA
| | - Rebecca Salomon
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB# 7460, Chapel Hill, NC, 27599, USA
| |
Collapse
|
43
|
Najman JM, Plotnikova M, Williams GM, Alati R, Mamun AA, Scott J, Wray N, Clavarino AM. Trajectories of maternal depression: a 27-year population-based prospective study. Epidemiol Psychiatr Sci 2017; 26:79-88. [PMID: 26781917 PMCID: PMC7137647 DOI: 10.1017/s2045796015001109] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/07/2015] [Indexed: 11/05/2022] Open
Abstract
AIMS To identify distinct trajectories of depression experienced by a population-based sample of women over a 27-year period and to assess the validity of the derived trajectories. METHOD The Mater University of Queensland Study of Pregnancy is a birth cohort study which commenced in 1981. Women (N = 6753) were interviewed at their first clinic visit, at 6 months, then 5, 14, 21 and 27 years after the birth of their child, using the Delusions Symptoms - States Inventory. Some 3561 (52.7%) women were followed up at 27 years, with 3337 (49.4%) of the sample completing the Composite International Diagnostic Interview (CIDI). Depression trajectories over a 27-year period were identified using Latent Class Growth Modelling (LCGM). LCGM was used to identify respondents with similar patterns of depression over a 27-year period. At the 27-year follow-up women who completed the CIDI, were stratified according to their trajectory group membership. RESULTS Three trajectory groups, each with different life-course patterns of depression were identified. The low/no symptoms of depression trajectory group comprised 48.4% of women. The mid-depression group (41.7%) had a consistent pattern of occasional symptoms of depression. The high/escalating trajectory group comprised 9.9% of the women in the study. We then examined each trajectory group based on their completion of the CIDI at the 27-year follow-up. Using the CIDI, 27.0% of women in the study had met the DSM-IV criteria for lifetime ever depression by their mean age of 46.5 years. The responses to the CIDI differed greatly for each of the trajectory groups, suggesting that the trajectories validly reflect different life histories of depression. The high/escalating trajectory group had an earlier age of first onset, more frequent episodes, longer duration of each episode of depression and experienced higher levels of impairment for their episodes of depression. For the high symptoms trajectory group, clinically significant depression is estimated to be experienced by women almost one in every 6 days of their life. CONCLUSION While symptoms of depression are commonly experienced in a large community-based sample of women, a minority of women experience many episodes of depression in their lifetime. It is this group of women who are most impaired and should be of most concern, and who should be the main target of prevention and treatment initiatives.
Collapse
Affiliation(s)
- J. M. Najman
- Schools of Public Health and Social Science, The University of Queensland, Brisbane, Australia
| | - M. Plotnikova
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - G. M. Williams
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - R. Alati
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - A. A. Mamun
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - J. Scott
- UQCCR, The University of Queensland, Brisbane, Australia
| | - N. Wray
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - A. M. Clavarino
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| |
Collapse
|
44
|
Kozyrskyj AL, Letourneau NL, Kang LJ, Salmani M. Associations between postpartum depressive symptoms and childhood asthma diminish with child age. Clin Exp Allergy 2016; 47:324-330. [PMID: 27770463 DOI: 10.1111/cea.12837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/16/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Affecting 19% of women, postpartum depression is a major concern to the immediate health of mothers and infants. In the long-term, it has been linked to the development of early-onset asthma at school entry, but only if the depression persists beyond the postnatal period. No studies have tested whether associations with postpartum depressive symptoms and early-onset asthma phenotypes persist into later school age. OBJECTIVE To determine associations between maternal postpartum depressive symptoms and childhood asthma between the ages of 5-10 by using a nested longitudinal design. METHODS Data were drawn from the 1994-2004 administrations of the Canadian National Longitudinal Survey of Children and Youth, which tracks the health of a nationally representative sample of children in Canada. Child asthma was diagnosed by a health professional, and maternal depressive symptoms were assessed by the Centre for Epidemiological Studies Depression scale. Analyses were conducted by using a multilevel modelling approach, in which longitudinal assessments of asthma in 1696 children were nested within the exposure of postpartum depression. RESULTS Postpartum depressive symptoms had a 1.5-fold significant association with childhood asthma between the ages 6-8. This was independent of male sex, maternal asthma, non-immigrant status, low household socioeconomic status, being firstborn, low birthweight, low family functioning and urban-rural residence, of which the first 4 covariates elevated the risk of asthma. Statistical significance was lost at age 8 when maternal prenatal smoking replaced urban-rural residence as a covariate. At ages 9-10, an association was no longer evident. CONCLUSIONS AND CLINICAL RELEVANCE Women affected by postpartum depressive symptoms are concerned about long-term health effects of their illness on their infants. Although postpartum depressive symptoms were associated with school-age asthma at ages 6 and 7, this association diminished later. Both home and school life stress should be considered in future studies on asthma development later in childhood.
Collapse
Affiliation(s)
- A L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - N L Letourneau
- Faculty of Nursing & Cumming School of Medicine (Pediatrics & Psychiatry), University of Calgary, Calgary, AB, Canada
| | - L J Kang
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - M Salmani
- Department of Mathematics & Statistics, University of New Brunswick, Fredericton, NB, Canada
| |
Collapse
|
45
|
Molgora S, Fenaroli V, Malgaroli M, Saita E. Trajectories of Postpartum Depression in Italian First-Time Fathers. Am J Mens Health 2016; 11:880-887. [PMID: 27885145 PMCID: PMC5675320 DOI: 10.1177/1557988316677692] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Paternal postpartum depression (PPD) has received little attention compared with maternal prenatal and postpartum depression, despite research reporting that paternal PPD concerns a substantial number of fathers. History of depression and antenatal depression have been identified as important PPD’s risk factors, underlining the continuity of depressive symptoms during the transition to parenthood. However, only few studies have focused on the evolution of depressive symptoms with longitudinal research design. The present study aims at analyzing the longitudinal trajectories of depressive symptoms from the third trimester of pregnancy to 1 year after childbirth. One hundred and twenty-six first-time fathers completed the Edinburgh Postnatal Depression Scale at four time points (7-8 months of pregnancy, 40 days, 5-6 months, and 12 months after childbirth). Data were analyzed throughout latent growth mixture modeling. Latent growth mixture modeling analysis indicated a three-class model as the optimal solution. The three-class solution included a trajectory of low, stable depressive symptoms across the four time points (resilient, 52%); a trajectory of moderate, relatively stable depressive symptomatology (distress, 37%); and a trajectory of emergent clinical depression following a pattern of high depressive symptoms (emergent depression, 11%). This study allowed to identify different subpopulation within the sample, distinguishing among mental well-being, emotional distress, and high-risk conditions when—1 year after childbirth—fathers report the highest scores to the Edinburgh Postnatal Depression Scale. These results underline the importance to analyze fathers’ well-being over the time during the transition to fatherhood.
Collapse
|
46
|
Musliner KL, Munk-Olsen T, Laursen TM, Eaton WW, Zandi PP, Mortensen PB. Heterogeneity in 10-Year Course Trajectories of Moderate to Severe Major Depressive Disorder: A Danish National Register-Based Study. JAMA Psychiatry 2016; 73:346-53. [PMID: 26934026 PMCID: PMC6015228 DOI: 10.1001/jamapsychiatry.2015.3365] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence suggests that long-term trajectories of major depressive disorder (MDD) are heterogeneous. The Danish Psychiatric Central Research Register (DPCRR) provides a rare opportunity to examine patterns and correlates of long-term trajectories in a large sample of patients with moderate to severe MDD. OBJECTIVE To characterize patterns and correlates of 10-year course trajectories of MDD in the DPCRR. DESIGN, SETTING, AND PARTICIPANTS A cohort containing 11 640 individuals born in Denmark in 1955 or later with their first recorded MDD diagnosis in the DPCRR between 1995 and 2002 was established. Patients were followed for 10 years from the date of their initial MDD diagnosis. Data were obtained from Danish civil and psychiatric national registers in June 2013 and were analyzed from April 4, 2014, to December 17, 2015. Correlates of trajectory class membership were sex, characteristics of the first recorded MDD episode (ie, age, severity, inpatient treatment, and record of suicide attempt or self-harm), and psychiatric diagnoses in parents (ie, depression, bipolar disorder, schizophrenia-spectrum disorders, substance abuse, and anxiety or somatoform disorders). MAIN OUTCOMES AND MEASURES The outcome variable was past-year contact at a psychiatric hospital with a main diagnosis of MDD during each of the 10 years following the initial MDD diagnosis. Trajectories were modeled using latent class growth analysis. RESULTS The sample included 11 640 individuals (7493 [64.4%] women) aged 18 to 48 years (mean [SD], 31.4 [7.3]) at their first recorded MDD diagnosis. Four trajectory classes were identified: brief contact (77.0%) (characterized by low probability of contact after 2 years); prolonged initial contact (12.8%) (characterized by high decreasing probability of contact during the first 5 years); later reentry (7.1%) (characterized by moderate probability of contact during the second 5 years); and persistent contact (3.1%) (characterized by high or moderate probability of contact throughout). Female sex (odds ratio [OR] range, 1.82-2.22), inpatient treatment (OR range, 1.40-1.50), and severity at first recorded MDD episode (OR range: moderate, 1.61-1.84; severe, 1.93-2.23; and psychotic, 2.73-3.07) were associated with more severe trajectories. Parental anxiety (OR, 1.34 [95% CI, 1.10-1.63]) and depression (OR, 1.63 [95% CI, 1.28-2.09]) were associated with the prolonged initial contact and later reentry classes, respectively. Parental schizophrenia was associated with the persistent contact class (OR range, 2.55-3.04). CONCLUSIONS AND RELEVANCE Most people treated for moderate to severe MDD in Danish psychiatric hospitals do not receive additional MDD treatment after 2 years; however, a minority receive specialty treatment for up to a decade. Observable heterogeneity in the course may be indicative of underlying etiologic differences.
Collapse
Affiliation(s)
- Katherine L Musliner
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark2The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark3Department of Mental Health, The Johns
| | - Trine Munk-Olsen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark2The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Thomas M Laursen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark2The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - William W Eaton
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Peter P Zandi
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Preben B Mortensen
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark2The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| |
Collapse
|
47
|
Musliner KL, Munk-Olsen T, Eaton WW, Zandi PP. Heterogeneity in long-term trajectories of depressive symptoms: Patterns, predictors and outcomes. J Affect Disord 2016; 192:199-211. [PMID: 26745437 PMCID: PMC4761648 DOI: 10.1016/j.jad.2015.12.030] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evidence suggests that long-term trajectories of depressive symptoms vary greatly throughout the population, with some individuals experiencing few or no symptoms, some experiencing transient symptoms and others experiencing chronic depression. The goal of this paper is to review studies that examined heterogeneity in long-term trajectories of depressive symptoms and summarize the current knowledge regarding (a) the number and patterns of trajectories and (b) antecedents and outcomes associated with different trajectory patterns. METHODS We conducted a systematic review of literature in the Medline and PsychINFO databases. Articles were included if they (a) modeled trajectories of depressive symptoms, (b) used a group-based trajectory modeling approach, (c) followed participants for 5+ years and (d) had a sample size of at least 200. RESULTS We identified 25 studies from 24 separate cohorts. Most of the studies identified either 3 or 4 distinct trajectory classes. Trajectories varied in terms of severity (low, medium, high) and stability (stable, increasing, decreasing). In most studies, the majority of participants had consistently few or no depressive symptoms, but a notable minority (usually <10%) reported persistent symptoms. Predictors of trajectories with greater symptom burden included female gender, lower income/education and non-white race. Other predictors were specific to different populations (e.g. mothers, older adults). High symptom burden trajectories were associated with poor psychiatric and social outcomes. LIMITATIONS Comparisons between studies were qualitative. CONCLUSIONS Trajectories of depression symptoms in the general population are heterogeneous, with most individuals showing minimal symptoms but a notable minority experiencing chronic high symptom burden.
Collapse
Affiliation(s)
- Katherine L Musliner
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
| | - Trine Munk-Olsen
- National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark
| | - William W Eaton
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| | - Peter P Zandi
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| |
Collapse
|
48
|
The role of self-esteem instability in the development of postnatal depression: A prospective study testing a diathesis-stress account. J Behav Ther Exp Psychiatry 2016; 50:15-22. [PMID: 25985253 DOI: 10.1016/j.jbtep.2015.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 03/20/2015] [Accepted: 04/23/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding vulnerability factors involved in the development of postnatal depression has important implications for theory and practice. In this prospective study, we investigated whether self-esteem instability during pregnancy would better predict postnatal depressive symptomatology than level of self-esteem. In addition, going beyond former studies, we tested the possible origin of this instability, examining whether day-to-day fluctuations in self-esteem could be explained by fluctuations in mood state, and whether this day-to-day self-esteem reactivity would predict postnatal depressive symptoms. METHODS 114 healthy never-depressed women were tested during the late second or third trimester of their gestation (Time 1) and at 12 weeks after delivery (Time 2). Day-to-day levels of self-esteem and depressed mood state were assessed at Time 1. At Time 2, postnatal depressive symptoms were assessed. RESULTS The results show that, after controlling for initial depressive symptomatology, age and socio-economic status, postnatal depressive symptomatology at 12 weeks after childbirth could be predicted by self-esteem instability and not level of self-esteem. In addition, multi-level analyses demonstrated that these changes in day-to-day levels of self-esteem are associated with changes in day-to-day levels of depressed mood state and that those subjects with greater prenatal self-esteem reactivity upon depressed mood report higher levels of depressive symptoms post-partum. LIMITATIONS We used paper and pencil day-to-day measures of state self-esteem, which can be subject to bias. CONCLUSION These results provide evidence for a diathesis-stress account of postnatal depression, highlighting the importance of a multi-dimensional view of self-esteem and the predictive role of self-esteem instability.
Collapse
|